History, Examinations & Investigations

After you’ve carried out a primary assessment and corrected any abnormalities, it’s time to dive deeper in with a full history and examination, whilst all the while thinking about what investigations you’d like done to narrow your differential diagnosis list.

Check out the “Clinical Lessons” for an easy to use and comprehensive matrix for taking a thorough history and examining a patient. Briefly, for the history, it’s now important to collect detailed information straight from the patient. This includes new changes and new symptoms. With the examination, your aim it to elicit any new signs or changes that’s going to help you with a diagnosis and decide upon an appropriate management plan beyond this acute episode.

The investigations are a favourite viva question. It’s always advised to have a clear structure in your head to make sure you don’t forget anything key. A good mnemonic I use is BUMERS:

B=bloods,

U=urine dip and urinalysis,

M=microbiology [cultures, serology, sensitivities etc.],

E= ECG, echocardiograms etc.,

R=radiology (CXR [chest x-ray - often always vital to order], AXR, CTs etc.) and finally,

S=special tests (e.g. spirometry for asthma).    

Consultants often probe into what bloods exactly you’d like to order. For this, I use the mnemonic FLUIC:

F=FBC [full blood count],

L=LFTs [liver function tests],

U= U&E [urea & electrolytes],

I= inflammatory markers [CRP, ESR etc.],

C= clotting factors.

And to extend this, there is also an ABCDE to attach to this:

A=ABG,

B=blood cultures,

C=creatinine, calcium, CXR

D=”dextrose” [glucose levels] and

E=ECG .